Power Doppler ultrasonography in the diagnosis of acute childhood pyelonephritis

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis (APN) is a challenge, particularly during infancy. In an attempt to differentiate APN from lower urinary tract infection (UTI), we evaluated the ability of power Doppler ultrasonography (PDU) to predic...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2004-09, Vol.19 (9), p.987-991
Main Authors: Halevy, Raphael, Smolkin, Vladislav, Bykov, Sergey, Chervinsky, Leonid, Sakran, Waheeb, Koren, Ariel
Format: Article
Language:English
Subjects:
Acute Disease
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Pyelonephritis - diagnostic imaging
Radionuclide Imaging
Radiopharmaceuticals
Sensitivity and Specificity
Technetium Tc 99m Dimercaptosuccinic Acid
Ultrasonography, Doppler
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Summary:In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis (APN) is a challenge, particularly during infancy. In an attempt to differentiate APN from lower urinary tract infection (UTI), we evaluated the ability of power Doppler ultrasonography (PDU) to predict renal parenchymal involvement, as assessed by dimercaptosuccinic acid ((99m )Tc-DMSA) scintigraphy. The study comprised 62 patients, 46 girls and 16 boys, aged 2 weeks to 5 years, admitted to the pediatric department with febrile UTI. All children were examined by PDU and DMSA scintigraphy within the first 3 days of admission. In the group of 31 patients with one or more DMSA scan abnormalities, the PDU showed a matching perfusion defect in 27 (87%). Of 26 children with normal DMSA scintigraphy, the PDU evaluation was also normal in 24. The sensitivity and specificity of PDU for the detection of affected kidneys were 87% and 92.3%, and the positive predictive value and negative predictive value were 93.1% and 85.7%, respectively. These data indicate the PDU has a high sensitivity and specificity for differentiating APN from lower UTI and may be a useful and practical tool for the diagnosis of APN in infants and children.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-004-1529-6